Provider Demographics
NPI:1336373562
Name:SWANSON, JAIME (DPT)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:205-023-6707
Mailing Address - Fax:720-398-8675
Practice Address - Street 1:7124 FEDERAL BLVD STE 800
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5520
Practice Address - Country:US
Practice Address - Phone:720-502-3670
Practice Address - Fax:720-398-8675
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000204869Medicaid